MEDICARE: AMANDA A. CANTWELL NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024174210	VA
2	363LF0000X	Family Nurse Practitioner	21722	TN

General Provider Information

NPI Number	:	1063962728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA A. CANTWELL NP

Provider Business Mailing Address
First Line	:	3225 E ANDREW JOHNSON HWY
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37745-0965
Country	:	US
Telephone Number	:	423-972-4770
Fax Number	:	423-485-6421

Provider Business Practice Location Address
First Line	:	3225 E ANDREW JOHNSON HWY
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37745-0965
Country	:	US
Telephone Number	:	423-972-4770
Fax Number	:	423-485-6421

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2016
Last Update Date	:	05/31/2023

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